Who receives RhoGAM (Rh immune globulin) administration?

From the Guidelines

RhoGAM (Rh immune globulin) should be administered to Rh-negative women who are pregnant with or have delivered an Rh-positive baby, or who have been exposed to Rh-positive blood, including those who have had a spontaneous or induced abortion at less than 12 weeks of gestation, as recommended by the Society for Maternal-Fetal Medicine 1. The administration of RhoGAM is crucial in preventing Rh sensitization and its associated complications, such as hemolytic disease of the newborn, which can lead to anemia, jaundice, or even fetal death.

• The standard dose of RhoGAM is 300 micrograms intramuscularly, although smaller doses (50 micrograms) may be used for early pregnancy events before 12 weeks 1.
• The use of RhoGAM has dramatically reduced the incidence of Rh sensitization and associated complications, and its administration is recommended in care settings where RhD testing and RhoGAM administration are logistically and financially feasible 1.
• In cases where RhoGAM administration may pose a challenge, such as in settings where access to the lower dose is limited, a 300 mg dose may be recommended 1.
• The Society for Maternal-Fetal Medicine supports access to abortion without unnecessary barriers and recommends offering RhoGAM administration if indicated, while also prioritizing access to abortion care 1. Key points to consider when administering RhoGAM include:
• The risk of RhD alloimmunization is low but not negligible, and prevention is critical to avoid adverse pregnancy and perinatal outcomes 1.
• The risks associated with RhoGAM administration are low, and the benefits of preventing Rh sensitization outweigh the potential risks 1.
• RhoGAM works by suppressing the maternal immune response to nonself D-antigen, although the complete mechanism of action is not fully understood 1.

From the FDA Drug Label

A large fetomaternal hemorrhage late in pregnancy or following delivery may cause a weak mixed field positive Du test result. If there is any doubt about the mother’s Rh type, she should be given Rho(D) Immune Globulin (Human). HyperRHO S/D Full Dose should be given to a pregnant woman only if clearly needed.

The pregnant woman receives RhoGAM (Rh immune globulin) administration, specifically those who are Rh-negative and at risk of sensitization to Rh-positive blood 2.

• The administration is given to prevent the formation of antibodies against Rh-positive blood in the mother.
• It is typically given to Rh-negative mothers who have been exposed to Rh-positive blood, either during pregnancy or after delivery 2.

From the Research

RhoGAM Administration

The administration of RhoGAM (Rh immune globulin) is crucial in preventing Rh alloimmunization in Rh-negative women. The following groups receive RhoGAM administration:

• Rh-negative nonsensitized women delivering an Rh-positive infant, who should receive 300 microg of anti-D Ig within 72 hours of delivery 3
• Rh-negative nonsensitized women at 28 weeks' gestation, when fetal blood type is unknown or known to be Rh-positive, who should receive 300 microg of anti-D Ig 3
• Nonsensitized D-negative women after miscarriage or threatened abortion, who should receive a minimum of 120 microg of anti-D if before 12 weeks' gestation and 300 microg after 12 weeks' gestation 3
• Nonsensitized D-negative women following ectopic pregnancy, who should receive a minimum of 120 microg of anti-D before 12 weeks' gestation and 300 microg after 12 weeks' gestation 3
• Nonsensitized D-negative women following molar pregnancy, because of the possibility of partial mole, unless the diagnosis of complete mole is certain 3
• Nonsensitized D-negative women after amniocentesis, chorionic villous sampling, or cordocentesis, who should receive 300 microg of anti-D 3

Special Considerations

• If anti-D is not given within 72 hours of delivery or other potentially sensitizing event, it should be given as soon as the need is recognized, for up to 28 days after delivery or other potentially sensitizing event 3
• Quantitative testing for fetomaternal hemorrhage (FMH) may be considered following events potentially associated with placental trauma and disruption of the fetomaternal interface 3
• Anti-D 120 microg or 300 microg is recommended in association with testing to quantitate FMH following conditions potentially associated with placental trauma and disruption of the fetomaternal interface 3

Effectiveness of RhoGAM Administration

• A single intramuscular injection of Rh immune globulin, 300 microg, is 88% effective in preventing Rh isoimmunization during pregnancy in Rh-negative primigravidas and in multigravidas treated antenatally in all previous pregnancies 4
• Antenatal prophylaxis with Rh immune globulin at 28 weeks' gestation is effective in preventing the development of Rh isoimmunization during pregnancy or within 3 days after delivery 5